In May, the New York Times Magazine published a piece by Jennifer Kahn entitled, “Can you call a 9-year-old a psychopath?” The online version generated a great deal of discussion, including 631 comments and a column from Amanda Marcotte at Slate comparing psychopathy and autism. Marcotte’s point seemed to be that if we accept autism as another variant of human neurology rather than as a moral failing, should we not also apply that perspective to the neurobiological condition we call “psychopathy”? Some autistic people to umbrage at the association with psychopathy, a touchy comparison in the autism community in particular. Who would want to be compared to a psychopath, especially if you’ve been the target of one?

In her Times piece, Kahn noted that although no tests exist to diagnose psychopathy in children, many in the mental health professions “believe that psychopathy, like autism, is a distinct neurological condition (that) can be identified in children as young as 5.” Marcotte likely saw this juxtaposition with autism and based her Slate commentary on the comparison. But a better way to make this point (and to avoid a minefield), I’d argue, is to stop mentioning autism at all and to say that any person’s neurological make-up isn’t a matter of morality but of biology. If we argue for acceptance of you and your brain, regardless how it works, we should argue for acceptance of people who are psychopaths. They are no more to blame for how they developed than people with other disabilities.

If being compared with a psychopath elicits a whiplash-inducing mental recoil, then you probably have a good understanding of why the autism community responded to Marcotte’s piece (and accompanying tweets) so defensively, even though her point was a good one. At its core, the argument is a logical, even humanistic one. When it comes to psychopathy, our cultural tendencies are to graft moral judgment onto people who exhibit symptoms of psychopathy, a condition once designated as “moral insanity.” We tend collectively to view the psychopath as a cold-hearted, amoral entity walking around in a human’s body, a literal embodiment of evil.

But those grown people whom we think of as being psychopaths were once children. What were our most infamous psychopaths like when they were very young? Was there ever a time when human intervention could have deflected the trajectory they took, turned the path away from the horror, devastation, and tragedy they caused, one that not all psychopaths ultimately follow? Can we look to childhood as a place to identify the traits of psychopathy and, once known, apply early intervention?

Clinicians and therapists have expended a great deal of energy discussing the notion of psychopathy and trying to pin it down and predict its course. Some portion of what we think of as psychopathy is genetic—yes, you can inherit tendencies—but another portion of it arises from variable environmental factors. The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), IV-TR, offers up six diagnoses related to antisocial behaviors in childhood, and none of them are especially predictive of who will become an adult psychopath. Indeed, most children who show what clinicians consider behaviors associated with psychopathy do not grow up to be psychopaths.

While there’s no perfect test of or predictor for psychopathy, the factors that can contribute to the condition may be a useful place to start, as described by forensic psychologist Katherine Ramsland in the article “The Childhood Psychopath: Bad Seed or Bad Parents?” Among these signs of dangerousness are a mother who shows a tendency toward isolation, a transient father, low frustration tolerance, a sense of omnipotence, cruelty toward others, and low birthweight or birth complications. The thing is, many of these features are known risk factors for other chronic problems—that is, they’re more general issues that could be addressed through psychological intervention, whether the child will later become a psychopath or not.

So what if, instead of using the “psychopath” label, we talked neutrally of less damning problems that need mitigation? We all have them. Some of us are fortunate enough to have shortfalls that are seen as foibles, earning chuckles from friends, family in-jokes, or visits to a therapist. Others of us get handed deeper troubles that are much more difficult to manage. Does that make us inherently “good” or “bad”? Biology doesn’t do “good” or “bad,” so let’s just dispense with this kind of judgment.

Accepting psychopathy as a brain condition, especially in children, could have positive results—as long as we dispense with the loaded word “psychopath.” The rationale is clear: The term crushes with a moral weight and accusatory tone. As the headline of Ramsland’s article and other articlesillustrate, we still have a strong tendency to moralize psychopathy, even if we’re writing about it as a neurobiological problem. A child who is a “bad” seed is one of Damien’s army or the boys from Brazil, a devil in child form, bent on evil, hopeless of remediation. And the parent of a psychopath is, obviously, a parent who has made a moral and parenting error, one so deep that their offspring is hopelessly lost to the dark side.

If we reduce the stigma of psychopathy, particularly as it relates to children, it would be it easier to identify children at risk and make more effective therapies available to them. Right now, research into and application of such therapies can be difficult given the social and moral burden that the terminology implies. Would you enter your child into a study needing “psychopaths” as participants? Wouldn’t you rather see a child labeled with “low frustration tolerance” or “low birthweight” than “shows early psychopathic tendencies”? In addition to being kinder and less stigmatizing, the former also provide for a tighter, more distinct target for intervention.

Labels like autism can have benefits: They can be a shibboleth among communities who relate to them, and under current constructs, serve as a passport to services. Rather than relying on stigmatized and shape-shifting labels for diseases, though, we’d often be better off looking to specific behavioral issues instead. That way we can help a child regardless of her neurobiological destiny.

Does it seem far-fetched that treatments like this would work? At least some experts have argued that personality traits are open to change during childhood and adolescence, observing that intervention may be “particularly effective” if targeted to the appropriate developmental periods and transitions. Skeem and colleagues note that early adolescence is an especially key period for emotional learning and intervention. For children who show what are now being designated as callous-unemotional traits (a lack of emotional empathy and guilt) coupled with signs of conduct disorder, intervention at these crucial periods could derail a child at risk of psychopathy from growing into a unemotional killer or narcissistic grifter.

But, you might argue, one of the most infamous manifestations of psychopathy is harm to others, particularly bodily harm or even death, although not all serial killers are psychopaths and not all psychopaths kill. Do we just sit back and accept these acts without moral judgment because “psychopathy” is a neurobiological construct and thus an excuse?

No. We do not. It’s one thing to have a particular inclination because of one’s genes or experiences during childhood and adolescence. It’s another thing entirely to break the law or harm and kill other human beings. You can accept that psychopathy can be partly inborn without using that acceptance to defend immoral behavior or abrogate human and social responsibility or safety. As Jennifer Skeem and colleagues observed in remarking the potential legal ramifications of associating reduced amygdala activity and psychopathy, “If a defendant manifests reduced amygdala activity while viewing aversive photographs in an fMRI scanner, this does not explain why he murdered his spouse 2 years ago.” The neurology itself is neither bad nor good, morally speaking, but harmful behaviors are obviously wrong, and society requires protection from them.

David Thoreson Lykken in the 1990s observed that the “hero and the psychopath are twigs on the same genetic branch,” remarking on shared traits of a seemingly fearless temperament. Like “heroes,” psychopaths may also be pretty good at strategic thinking, although their version of it can be marked by an absence of conscience, emotional empathy, or altruistic inclinations. What benefit could society accrue by ameliorating callous-unemotional traits or building emotional empathy while not wiping out potentially heroic fearlessness or a capacity to excel at strategic thinking? Would it make the difference, as the mother in Kahn’s Times article wryly remarked, between a child’s growing up to be a Nobel prize winner or a serial killer?

Regardless of what we target in children who are at risk of “dangerousness” or being “callous-unemotional,” let’s just not call them psychopaths while we’re doing it. I’m in agreement with Marcotte and others that we should accept that it’s not a moral failing any more than any other neurobiological make-up. But given the extreme unlikelihood that the world will ever perceive benefits of psychopathy–even if some of its traits could potentially be beneficial–it’s one label we need to dispense with entirely, even as we accept its neurobiological basis.

I am Dr. David Thoreson Lykken’s eldest son. Dad was recognized as one of the world’s foremost experts on the psychopath, and he did indeed believe that a child as young as nine could be correctly diagnosed as such. It was his hope to develop a diagnostic tool that would allow us to identify young psychopaths and then help them use their particular talents in a beneficial manner. Sadly, the juvenile correctional field (of which I was a part) isn’t big on letting psychologists “experiment” on their charges, and Dad simply ran out of time. As for the autism nonsense, I have three autistic kids myself. Unlike psychopathy, I believe that there is a huge environmental factor in autism, but it is certainly true that “bad parents” are not the cause of either condition. Watch “The Bad Seed” if you want to understand child psychopaths. It was one of Dad’s favorites.

http://scienceblogs.com/gregladen/ Greg Laden

Interesting. I agree with you that it is not very comfortable to allow the apparent partial conflation of something being “neuro-psychological” and linked blamelessly to behavior. The modal Y-chromosome bearing male human is bellicose, rapes now and then, and smells bad. These behaviors observed over the centuries are just as “neuro-psychological” as whatever we tend to link with psychopathy might be. Shall we just rename them and accept them? (Actually we have … it’s called “boys will be boys”)

AG

If word “psychopath” sounds bad, other word will emerge and mean the same thing. Just like quantity easing = inflation. Since people hate inflation, politicians invent new words for the same thing.

keith

I’m autistic and the only people I’ve ever felt comfortable with were psychopaths or other autistics. I find them deeply interesting with regards to the nature of autism, and humanity, and therefore the universe as we perceive it. They feel safe to me because they don’t hold onto beliefs about the social hierarchy, they certainly aren’t part of the hierarchy that determines how nonautistics see the world, and yet they desperately need to control it. It’s really fascinating to imagine their viewpoint and contrast it with viewpoints of autistics and nonautistics.

They’re very popular socially though, so I wouldn’t feel sorry for them.

keith

Oh, and in my experience of high functioning psychopaths they’re basically harmless, but their non-psychopath, non-autistic, everyday normal people type minions can be highly dangerous, and I suspect have been highly dangerous in the everyday violence we see in genocides and such. I think the Milgram experiment shows why psychopathy won’t be examined any more honestly than autism: ordinary people are murderers if it pleases someone above them in the hierarchy, and psychopaths want to be that person being appeased.

I’d be delighted and more than a little surprised if a nonautistic, nonpsychopathic scientist started from the question “How is my ape mind twisting the way I see things?” rather than “What is wrong with these other people?”

Jesse Lykken, JD

My best friend is a psychopath. He is now in his early 50s and holds a responsible position in county government. He has always been fully aware of his … abilities … and appreciates the fact that if not for his wonderful parents, he would be either dead or in prison. He chose for himself a strong moral code, and strictly adheres to it. With practice, he has done away with impulsive behaviors that would be damaging to himself or to others. My father thought my friend to be a perfect example of a socialized psychopath, and believed that parenting was the key factor. As for my friend, well, I am very glad that he is my friend. Oh, and he does very well with my autistic children. His very presence puts most people on their guard, but my kids don’t have the same social antennae as typical folks do, and therefore have no innate fear of him. He senses this, and therefore reacts favorably to them. It’s kind of cool, actually.

http://www.doublexscience.org/ Emily Willingham

Keith and Jesse, I find your observations fascinating.

http://backseatdriving.blogspot.com/ Brian Schmidt

Early intervention seems helpful for autistic children. Whether it would help for children with psychopathic-type conditions will be less clear, but might as well try. The NYTimes article does warn of the danger – teaching kids to fake moral behavior instead of incorporating moral behavior into their own personal preferences.

Regarding names, I think #3 is right that a new name will acquire the same stigma, but maybe it’ll help for a decade or two before the stigma develops. Then time to change the name yet again.

Jesse Lykken, JD

We all fake moral behavior to some extent. What seems to work with young psychopaths is to not let them get bored, AND to not let them get bored. Did I mention that letting them get bored is a really bad idea? While we flood them with constructive stimulation, praise them sincerely and often for being able to do things that most of us would wet ourselves for even considering. Eventually, the young, engaged psychopath will see that s/he has a favored place in our society, and is appreciated for what s/he is. Now, the young psychopath has been really and truly socialized, and can lead our first manned mission to Mars, or run for president (T.R.!). I wouldn’t change the word. It has just gotten bad P.R. One changes that with good P.R. Take the term out of the shadows, make sure it is differentiated from “sociopath”, and sing out “psychopathy rocks!” Just don’t let them get bored…

keith

I don’t think they can learn. But they’re huge fun, and so long as you don’t get emotionally involved they’re no problem. Every autistic should have a psychopath, imo. They make social interaction infinitely easier because people don’t enforce rules for the them in the way they would for an autistic by themselves.

George C Saufley

Could it be that we live in a “quantum universe” a child can be “blindly obedient to a parents culture, parent’s demands,fear of punishment etc. . In some communities it was a custom to put excess animals “cats” kittens into a sack and drown them in the river. If the cats and kitten got out of the bag and the child drowned them individually. A witness on the bank of the river might consider the child a “psychopath” and even adults in that community could call the child a “psychopath” When one fights in a war to protect the a country you are being “blindly obedient” to the officers who benefit from “delegating pathology” to kill the “enemy and collateral damage” Some moderate pathology or at least scientifically understanding may be essential for survival. No I don’t kill kittens anymore I rescue them.

dje3

I read the original article. That isn’t the problem at all. This kid is a danger to his parents and siblings. I would not trust him with a pet or other kid!

dje3

The question I came up with after all this is “Did the parents spank the kid when he was young?”
The answer in my mind is most definitely NO. I don’t care what problem a child has, when it endangers the child, other children or the parents (and the parent’s rights as parents) then the child needs to be SPANKED and spanked good. The spanking takes several things none in anger but immediate. The notification that a violation after warning has taken place and that the spanking will take place. The spanking. The after talk including how much it hurts ME to have to spank you and the reiteration of why the spanking happened. The promise that it will not happen again from the child. Hugging.
One can use the force of a feather and bring a child to deep tears. Yes it is emotional fear. Fear that is actually deep and actually restructures the mental process. The child KNOWS that if they do this again, they will be placed into this condition. They change and do not do it again.

From what I read of this child, I would be afraid to let any of my other children be in the same room unwatched. He is a danger to his siblings and any psychologist that hasn’t told the parents this deserves to be sued when it happens, because it will.

This is society’s fault and the parents fault. They let their child run amok because they believed in “gentility”. Well guess what? I am extremely gentle with my children. I love them deeply. I love them enough that I made sure that they knew the limits and knew the consequences of their actions. Actions without consequence are the issue.